Quality Assurances

As is the standard for participation in any federal Medicaid waiver, there are required quality assurances. They are:

The State Medicaid Agency (Medi-Cal) retains administrative authority over the Waiver program.

Level of Care need determinations are consistent with the need for institutional care.

Only qualified providers may serve Waiver participants.

Service plans (F-CAPs) are responsive to Waiver participant's needs.

Safeguards are taken to protect the health and welfare of persons receiving services under the HCBS (Home and Community Based Services) Waiver.

The state provides financial accountability for the Waiver.

In order to demonstrate compliance with the assurances, Children’s Medical Services (CMS) was required to develop performance measures in these six categories: Administrative Authority, Level of Care, Qualified Providers, Service Plans, Health & Welfare, and Financial Accountability. For each performance measure, CMS designated various data sources and the responsible parties for data collection. Each performance measure addresses how CMS will discover problems in each category and seek to remediate them.